Review of Australian Government Health Workforce Programs

1.2 Health workforce programs summary

Page last updated: 24 May 2013

The bulk of the Australian Government’s health workforce programs are managed by Health Workforce Division (HWD), with a stated mission to develop and implement policies and innovative strategies to improve the capacity, quality and mix of Australia’s health workforce.

The division manages total funding of over $5.9 billion across the forward estimates, up to $1.5 billion per year.

The various activities funded by the division are centred on supporting health service delivery though programs designed to expand the numbers, ensure the quality and encourage the distribution of health professionals. Funding activities focus on the health workforce more broadly, as well as rural workforce development, with aims including to:

  1. Increase the number of health professionals working in regional, rural and remote Australia.
  2. Support rural teaching, training and infrastructure.
  3. Establish Health Workforce Australia to ensure improvements in Australia’s health workforce planning capacity and ability to promote workforce innovation and reform.
  4. Support the Commonwealth’s engagement with the National Registration and Accreditation Scheme.
  5. Build the health workforce, through targeted medical education and training programs as well as nursing and allied health scholarships.
  6. Support rural health practitioners (including locum support to enable health practitioners to keep their skills up to date).
  7. Improve the health education and training opportunities for Aboriginal and Torres Strait Islander people.
  8. Expand the dental workforce, particularly in regional, rural and remote Australia and the public sector.

The Health Workforce Fund

In the 2011-12 Budget the Government announced the establishment of flexible funds for the Health and Ageing portfolio whereby 159 predominantly grant programs were consolidated into 18 new or expanded flexible funds with the expressed aim of cutting red tape for grant holders, increasing flexibility, and more efficiently providing evidence-based funding for the delivery of health outcomes in the community. This process included the establishment of the Health Workforce Fund (HWF).

The total value of funds available under the HWF is up to $4 billion over the period 2012-13 to 2015-16. Through the fund, via her Department, the Minister for Health, who is the key decision maker for the HWF, expends funds to strengthen the capacity of the health workforce to deliver high quality care by targeting the following areas which have been nominated as priorities:

  1. Increase the supply of workers in all health professions – and facilitate a more even distribution of workforce in terms of geography and of the types of services provided.
  2. Ensure a capable and qualified workforce – through registration, accreditation, training and development.
  3. Support the Indigenous health workforce –throughactivities that promote an increase in the Aboriginal and Torres Strait Islander health workforce and increase the capacity of the broader health workforce to address the needs of Indigenous people.
  4. Address health workforce shortages in regional, rural and remote Australia – through, for example, rural workforce programs and better targeting of workforce incentives.

There are currently 24 activity areas under the HWF. The Health Minister is responsible for approving the identified priority areas for activities under the fund, as well as approving individual items of expenditure.

The flexible arrangements for the fund mean that underspent funds can be readily deployed towards other activity areas experiencing high demand, provided this reallocated investment aligns with the government’s priorities.

Existing Health Workforce Division programs

Ongoing programs managed by the Health Workforce Division include:

  • The Rural Health Multidisciplinary Training program, which includes the Rural Clinical Training and Support program, the University Departments of Rural Health program and the Dental Training Expanding Rural Places program.
  • A large number of scholarship programs, including scholarships for doctors (the Rural Australia Medical Undergraduate Scholarship Scheme, the Medical Rural Bonded Scholarships and procedural training for GPs), the Nursing and Allied Health Scholarship and Support Scheme, Puggy Hunter scholarships for indigenous health students and Rotary scholarships.
  • The Bonded Medical Places program which applies to 25% of all new medical school places and imposes a return of service obligation in Districts of Workforce Shortage for students taking up those places.
  • The funding agreement with General Practice Education and Training Limited (GPET) for vocational training of doctors under the Australian General Practice Training program and the junior doctor rotations provided under the Prevocational General Practice Placements Program.
  • Other GP training programs including the Remote Vocational Training Scheme, and organisational support for General Practice Registrars Australia.
  • The Specialist Training Program, which supports vocational specialist trainees to rotate through an expanded range of settings beyond traditional public teaching hospitals. Since 2010 the STP has provided a single platform for Commonwealth grants support for specialist training initiatives.
  • New dental workforce programs, including the Voluntary Dental Graduate Year Program and the Oral Health Therapist Graduate Year Program, and the new rural relocation and retention and infrastructure program for dentists in key areas of need.
  • Support for peak Aboriginal and Torres Strait Islander health workforce organisations, to assist them with mentoring and developing Aboriginal and Torres Strait Islander health workers and professionals.
  • The Practice Nurse Incentive Program, which encourages general practices to employ nurses and allied health professionals to provide a range of expanded services.
  • The General Practice Rural Incentives Program, which encourages doctors to practice in regional, rural and remote communities through scaled financial incentives, and promotes careers in rural medicine.
  • Other programs to encourage rural medical practice include the scaled HECS Reimbursement Scheme and the National Rural Locum Program, which provides support to rural communities and their practitioners, particularly for those requiring obstetrics and anaesthetics skills.
  • The Telehealth Support Program, which funds a large number of organisations to provide innovative training tools and support to assist the health workforce in adapting to and delivering Telehealth services, until the end of 2012-13.

Appendix i outlines the detail of funding provided to HWD initiatives across the forward estimates.

While the overwhelming majority of the Department's workforce programs are managed by HWD there are instances where key initiatives are located elsewhere in the Department. Examples of such programs include:

  • Aged care workforce initiatives, including scholarships (Ageing and Aged Care Division).
  • Pharmacy scholarships and training investments such as pharmacy academics (Pharmaceutical Benefits Division).
  • The teaching component of the Practice Incentives program (managed by Primary and Ambulatory Care Division).
  • The dental capital and workforce fund (Acute Care Division). Note this program is not currently included in the workforce funding figures as it has not yet been implemented.

Appendix i also outlines the health workforce programs managed outside the Health Workforce Division which directly involve health workforce development.

To maintain this review at a feasible size, programs which are managed elsewhere in DoHA that are primarily focused on service delivery arrangements, rather than health workforce, have been considered out of scope for this project and have not been included within the specific program analysis. These programs include the Practice Incentives Program, the Medical Specialist Outreach Assistance Program and the Mental Health Nurse Incentive Program. Nevertheless, such initiatives do have linkages with workforce programs, are of keen interest to stakeholders and at times, necessarily there will be discussion of the intersection of these programs with those covered within the terms of review.

It is probably unremarkable to note that in an organisation the size of DoHA, challenges to effective communication and coordination will frequently arise. Based on observations in the course of this review, there is a need for a mechanism to ensure that workforce development issues are more systematically considered by staff in policy and program areas across the Department. This will be more fully discussed in a later chapter.

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Growth in funding

It is clearly the case that Australian Government funding for health workforce initiatives has increased substantially over the last decade. This reflects a number of factors including:

  • enhanced efforts to improve rural workforce distribution;
  • substantial growth in the number of graduating students across a number of disciplines, particularly medicine and nursing, requiring increased investment in existing programs such as the Australian General Practice Training Program and the Specialist Training Program;
  • new partnership agreements through the Council of Australian Governments (COAG) and the establishment of Health Workforce Australia (HWA);
  • increased Australian Government focus on supporting the development of the nursing and allied health workforce such as the Practice Nurse Incentives Program; and
  • new investment to support the development of the aged care workforce.

Figure 1.1 shows the growth in total (Commonwealth) health workforce program expenditure since 2004-05 and projected growth under the forward estimates (noting this includes all workforce programs managed across the department):

Figure 1.1: Total workforce program expenditure

Figure 1.1: Total workforce program expenditure D

Source: Health Workforce Division Administered Funding Summary, 2012 (unpublished)

The overall growth in funding for workforce programs reflects a substantial expansion in the number of trainees across all health disciplines in this period.

Distribution of funding

At the same time as the Australian Government’s investment in health workforce programs has increased, the allocation of funds for new purposes to meet government priorities and to support the development of different professional groups has begun to change.

Figure 1.2 shows that in 2006-07 the bulk of the government’s overall investment was to support training and incentive programs for medical graduates such as GP Training, Rural Workforce Incentives (for doctors) and the Rural Health Multidisciplinary Training Program (where the greatest proportion of funding supports rural training for medical students).

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Figure 1.2: Total funding by workforce group – 2006-07

Figure 1.2: Total funding by workforce group – 2006-07 D

Source: Health Workforce Division Administered Funding Summary, 2012 (unpublished)

By 2012-13 the distribution of funding between professional groups shows a degree of change, reflecting large investments in the Practice Nurse Incentive Program (noting that this is directed through general practices) and the aged care workforce (primarily nursing based), as well as new investments in dental training measures and multidisciplinary scholarships. Figure 1.3 outlines this.

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Figure 1.3: Total funding by workforce group – 2012-13

Figure 1.3: Total funding by workforce group – 2012-13 D

Source: Health Workforce Division Administered Funding Summary, 2012 (unpublished)

Note that the growth in expenditure on “Workforce Development and Regulation” in this period includes the establishment of HWA, with investment in better workforce planning and data systems.

The scale of the change in the funding profile is more apparent when 2006-07 funding is compared directly to 2012-13 allocations, as shown in Figure 1.4.

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Figure 1.4: Total funding by workforce group

Figure 1.4: Total funding by workforce group D

Source: Health Workforce Division Administered Funding Summary, 2012 (unpublished)

While there has been substantial investment in new professional groups in recent years, the level of funding for programs targeted at medical graduates has also increased. This includes additional funding for specialist training and substantial growth in the ongoing investment in GP training places, reflecting commitments made by the Government through the current National Partnership Agreement for Health and Hospital Reform.

Figure 1.5 shows real and projected growth in funding across professional groups since 2004-05.

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Figure 1.5: Growth in funding by workforce group

Figure 1.5: Growth in funding by workforce group D

*NB – “Multidisciplinary” relates to programs that provide funding for more than one health discipline, including Medicine, Nursing and Midwifery or Allied Health.

Source: Health Workforce Division Administered Funding Summary, 2012 (unpublished)

Figure 1.6 shows the growth in overall health graduates (all disciplines) compared to consolidated health workforce program funding.

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Figure 1.6: Growth in health graduates

Figure 1.6: Growth in health graduates D

*NB – graduate numbers include Medicine, Nursing and Midwifery, Dentistry and 17 Allied Health disciplines.

Source: Health Workforce Division Administered Funding Summary, 2012 (unpublished)

It is clear from Figures 1.1 through to 1.6 that the Commonwealth has substantially enhanced its focus on health workforce development over the last decade, with unprecedented intervention to address national health workforce supply pressures to meet community needs. The expansion to workforce supply has been complemented by a much more diversified investment in support and distribution mechanisms across professional groups, while still maintaining a strong focus on more traditional Commonwealth activities targeting medical workforce development.

The complex challenges facing the Commonwealth in undertaking national workforce planning and influencing workforce development across all professional groups are described in more detail in Chapter 2 to follow.